Provider Demographics
NPI:1326093725
Name:ATKINSON, JOLENE CAROL (MSW)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:CAROL
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:CAROL
Other - Last Name:ATKINSON-KRUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2102 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1135
Mailing Address - Country:US
Mailing Address - Phone:563-359-4049
Mailing Address - Fax:563-359-4069
Practice Address - Street 1:2102 E 38TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1135
Practice Address - Country:US
Practice Address - Phone:563-359-4049
Practice Address - Fax:563-359-4069
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA009751041C0700X
IL1490079851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI 16009Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
IA14447Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER